| NPI | 1821191719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX J0186) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN G40533) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2012-01-10 |